overweight vs. obesity tolerable weight the weight loss dilemma eating disorders physiology of...

Overweight vs. Obesity

Tolerable Weight

The Weight Loss Dilemma

Eating Disorders

Physiology of Weight Loss

Exercise: The Key to Weight Management

Losing Weight the Sound and Sensible Way

Daily Food Logs

Behavior Modification & Weight Management

Chapter 5

Weight Management

CHAPTER

OUTLINE

Key TermsOverweight: Excess body weight against a given standard, such as height or recommended percent body fat; less than obese

Obesity: A chronic disease characterized by excessive body fat in relation to lean body mass; usually at least 30% above recommended body weight


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5.1Percentage of U.S. Adults Who Are Overweight and Obese

Obesity: Having a very high amount of body fat in relation to lean body mass, a Body Mass Index (BMI) of 30 or higher, or being 30 pounds or more overweight

Body Mass Index (BMI): A measure of an adult’s weight in relation to his or her height, specifically the adult’s weight in kilograms divided by the square of his or her height in meters

5.2Definitions for CDC’s Obesity Trends among U.S. Adults between 1985 and 2003

5.2Obesity* Trends among U.S. AdultsBRFSS, 1985

20%–24 %15–19%<10%No Data ≥25%10%–14%

*Based on a BMI ≥ 30 or 30

lbs overweigh

t


20%–24 %15–19%<10%No Data ≥25%10%–14%


lbs overweigh

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Health Consequences of Obesity

Obesity is a risk factor forHypertension

Congestive heart failure

High blood lipids

Atherosclerosis

Stroke

Thromboembolitic disease

Varicose veins


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Health Consequences of Obesity

Obesity is a risk factor forType 2 diabetes

Osteoarthritis

Gallbladder disease

Sleep apnea

Ruptured intervertebral disks

Arthritis

Cancer (breast, colon, and prostate)


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Tolerable WeightMany people want to lose weight so they will look better—that’s a noteworthy goal

The problem, however, is that they have a distorted image of what they would really look like if they reduce to what they think is their ideal weight

Hereditary factors play a big role and only a small fraction of the population have the genes for a “perfect body”


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Tolerable WeightThe media has the greatest influence on people’s perception of what constitutes ideal body weight

Most people use fashion, fitness, and beauty magazines to determine what they should look like


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Tolerable WeightThe “ideal” body shapes, physiques, and proportions seen in these magazines are rare and essentially achieved only through airbrushing and medical reconstruction


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Tolerable WeightMany individuals, and primarily young women, go to extremes in an attempt to achieve these unrealistic figures

Failure to attain a “perfect body” may lead to eating disorders in some individuals


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Tolerable WeightAs people set their own target weight, they should be realistic

Attaining an excellent body-fat value is extremely difficult for some


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Tolerable WeightAn excellent body fat value is extremely difficult to maintain, unless people are willing to make a commitment to a VIGOROUS LIFETIME EXERCISE PROGRAM AND TO PERMANENT DIETARY CHANGES

Few people are willing to do that – thus, the moderate percent body fat category may be more realistic for many people


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Tolerable WeightA question you should ask yourself is: Are you happy with your weight?

Part of enjoying a higher quality of life is being happy with yourself

If you are not, you either need to do something about it or learn to live with it!


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Tolerable WeightIf you are above the moderate percent body fat category, you should try to come down and stay in this category, for health reasons: this is the category in which there appears to be no detriment to health


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Tolerable WeightIf you are in the moderate category but would like to be lower, you need to ask yourself a second question: How bad do I want it?

Do you want it bad enough to implement lifetime exercise and dietary changes?

If you are not willing to change, you should stop worrying about your weight and deem the moderate category as “tolerable” for you


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5.3

Differences Between Self-Reported and Actual Energy Intake and Physical Activity in Overweight People

Critical ThinkingDo you consider yourself overweight?

If so, how long have you had a weight problem, what attempts have you made to lose weight, and what has worked best for you?


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Impact of Excessive Weight65 million Americans are overweight or consider themselves to be overweight

Of these, 30 million are obese

50% of all women and 25% of all men are on diets at any given moment

People spend $40 to $50 billion yearly attempting to lose weight and another $30 billion on diet food sales


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Ideal vs. RecommendedBody Weight

No such thing as “ideal” weight“Recommended” weight is a better termRecommended weight varies among people

Two overweight individuals at the same weight—if one has risk factors due to genetics or dietary habits, this individual is at higher risk for disease and a lower weight may be recommended


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Diet Crazes

Fad diets continue to appeal to people of all shapes and sizes

These diets may work for a while but their success is usually short lived“When I get the latest fad diet, I imagine a trick birthday cake candle that keeps lighting up and we have to keep blowing it out” -Kelly Brownell (foremost weight management researcher)


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Low-Carb/High-Protein (LCHP) Diets

A few studies suggest that, short-term, LCHP diets are more effective for weight loss than carbohydrate-based diets. These results are preliminary and controversial.In LCHP diets:

A large amount of weight loss is water and muscle protein, not body fat. Some of this weight is quickly regained when regular dietary habits are resumed


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Few people are able to stay with LCHP diets for more than a few weeks at a time; the majority stop dieting before the targeted program completionLCHP dieters are rarely found in a national weight-loss registry of people who have lost 30 pounds and kept them off for a minimum of six yearsFood choices are severely restricted in LCHP diets; with less variety, individuals tend to eat less (800 to 1,200 calories/day) and thus lose more weight


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LCHP diets may promote heart disease, cancer, and increase the risk for osteoporosisLCHP diets are fundamentally high in fat (about 60 percent fat calories)LCHP diets are not recommended for people with diabetes, high blood pressure, heart disease, or kidney diseaseLCHP diets do not promote long-term healthy eating patterns


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How to Recognize Fad Diets

Are nutritionally unbalanced

Are based on testimonials

Were developed according to “confidential research”

Promote rapid and “painless” weight loss

Promise miraculous results


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Restrict food selectionRequire the use of selected productsUse liquid formulas instead of foodsMisrepresent salespeople as individuals qualified to provide nutrition counselingFail to provide information on risks associated with weight loss and diet use


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Do not involve physical activityDo not encourage healthy behavioral changesAre not supported by the scientific community or national health organizationsFail to provide information for weight maintenance upon completion of diet phase


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Eating DisordersAnorexia nervosa, bulimia nervosa, binge-eating disorder: physical and emotional conditions thought to stem from individual, family, and social pressuresEating disorders are increasing steadily in most industrialized nations where society encourages low-calorie diets and thinness


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Eating DisordersIntense fear of becoming fat does not disappear even when losing extreme weight

Individuals clip images from magazines to use as their ideal body goal

Articles on dangers of eating disorders fail to deter behavior in these individuals; instead, they look for ideas in these articles to use in their search for a "perfect body"


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Key TermAnorexia nervosa: An eating disorder characterized by self-imposed starvation to achieve and maintain very low body weight


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Anorexia NervosaIndividuals suffering from anorexia nervosa:

Refuse to maintain body weight over a minimal normal weight

Perceive themselves as overweight even when emaciated

Deny their condition

Have an intense fear of gaining weight even though underweight

May fear weight gain more than death by starvation


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Key TermBulimia nervosa: An eating disorder characterized by a pattern of binge eating and purging in an attempt to lose weight and maintain low body weight


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Bulimia NervosaBulimics usually are healthy-looking, well-educated, and near recommended body weight

They seem to enjoy food and often socialize around it

They have emotional challenges, rely on others, lack self-confidence

For them, recommended weight and food are abnormally important


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Bulimia NervosaPeople suffering from bulimia nervosa:

Fear gaining weight

Have recurrent episodes of binge eating

Feel stress after binge eating

Practice self-induced vomiting, fasting, and excessive exercise and misuse laxatives and medications

Evaluate themselves based on body shape and weight


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Key TermBinge-eating disorder: An eating disorder characterized by uncontrollable episodes of eating excessive amounts of food within a relatively short time


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Binge-Eating DisorderEating an unusually large amount of foodEating until uncomfortably fullEating out of controlEating much faster than usual during binge episodesEating alone due to embarrassment by how much food is consumedFeeling disgusted, depressed, or guilty after overeating


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Energy-Balancing EquationWeight maintenance: Calories in = calories out

Weight gain: Calories in > calories out

Weight loss: Calories in < calories out


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5.4Components of Total Daily Energy Requirement

Critical ThinkingIs there a difference in the amount of food that you are now able to eat compared with the amount that you ate in your mid- to late-teen years?If so, to what do you attribute these differences?What actions are you taking to account for the difference?


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1 pound of fat:3,500 calories


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Traditional Weight-Loss Concepts

Balancing food intake against output allows a person to achieve recommended body weightOverweight people just eat too muchIt really does not matter to the human body how much (or little) fat is storedSome truth to these statements, but still open to debate and research


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Setpoint TheoryA weight-regulating mechanism, located in the hypothalamus of the brain, regulates how much the body should weigh

Setpoint sets the amount of body fat it considers necessary and works tirelessly to maintain it

Setpoint functions like a thermostat: it detects fluctuations in weight and makes adjustments in energy metabolism and appetite


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Setpoint TheoryThe setpoint has a profound effect on amount of food you eat

As you lose weight, it signals hunger

As you gain weight, it reduces appetite

As you overeat, triggers body to “waste”

As you don’t eat enough, triggers body to “conserve”


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Setpoint TheoryTwo most common obstacles to weight loss

Genetics

Lifestyle

Setpoint illustrates how genetics and lifestyle overlap

The setpoint range is determined by genetics

Where the individual ends up in the range is a result of lifestyle


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Research and SetpointThe body resists maintenance of altered weight

Obese and lifetime non-obese individuals were used

Following a 10% weight loss, body attempted to regain the lost weight, burning up to 15% fewer calories

Following a 10% weight gain, the body attempted to lose weight, burning 10–15% more calories than expected

Results imply that after a 10% weight loss, a person would have to eat less or exercise more to account for the estimated deficit of 200 to 300 daily calories


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Factors That May Influence the Setpoint

Setpoint increases with

Constant dieting

Excessive fat intake

High sugar intake

Metabolic and body composition changes associated with aging

Setpoint decreases with

Aerobic exercise

Smoking (more detrimental than the extra weight)


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Weight Gain and Body Composition Changes

Starting at age 25, the typical American gains 1 pound of weight per year

By age 65, the average adult will have gained 40 pounds of weight

Because of the typical reduction in activity as we age, each year people also lose half a pound of lean tissue

Therefore, over this span of 40 years, there is an actual fat gain of 60 pounds accompanied by a 20-pound loss of lean body mass


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5.5Effects of Types of Diet and Exercise on Weight Loss

5.6Body Composition

Changes as a Result of Frequent Dieting

without Exercise

5.7

The Role of Diet and Exercise on Weight Loss

5.8

Effects of Daily Energy Expenditure on Percent of Weight Regained Following a Weight Reduction Program

Low-Intensity vs. High-Intensity

Some individuals promote low-intensity exercise over high-intensity for weight loss purposesCompared with high intensity, a greater proportion of calories burned during low-intensity exercise are derived from fatThe lower the intensity of exercise, the higher the percentage of fat utilization as an energy source


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In theory, if you are trying to lose fat, this principle makes sense, but in reality it is misleadingThe bottom line when you are trying to lose weight is to burn more calories—when your daily caloric expenditure exceeds your intake, weight is lostThe more calories you burn, the more fat is lost


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During low-intensity exercise, up to 50% of the calories burned may be derived from fat, the other 50% from glucose (carbohydrates)With intense exercise, only 30 to 40% of the caloric expenditure comes from fatOverall, however, you can burn twice as many calories during high-intensity exercise and, subsequently, more fat as well


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For example:If you exercise for 30 to 40 minutes at moderate intensity and burn 200 calories, about 100 of those calories (50%) would come from fatIf you exercise at high intensity during those same 30 to 40 minutes, you can burn 400 calories—with 120 to 160 of the calories (30 to 40%) coming from fat


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Whereas it is true that the percentage of fat used is greater during low-intensity exercise, the overall amount of fat used is still less during low-intensity exercise

If you exercise at a low intensity, you would have to do so twice as long to burn the same number of calories


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5.2

Comparison of Energy Expenditure between 30 and 40 Minutes of Low-Intensity vs. High-Intensity Exercise

Exercise: The Key to Lifetime Weight Management

The most effective way to tilt energy balancing equation in your favor is through physical activityResearch shows that a combination of diet and exercise is the most effective way to lose weightMaintenance of exercise program appears to be the best predictor of long-term weight loss maintenance


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“Physical inactivity is certainly a major, if not the primary, cause of obesity in the United States today. A certain minimal level of activity might be necessary for us to accurately balance our caloric intake to our caloric expenditure. With too little activity, we appear to lose the fine control we normally have to maintain this incredible balance. This fine balance amounts to less than 10 calories per day, or the equivalent of one potato chip.”

Dr. Jack Wilmore


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Weight Loss Recommendations

Have a desire to do so

Make lifetime changes in eating habits

Increase physical activity

Make a sensible decrease in caloric intake


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Increase Physical ActivityAccumulate 60 minutes of activity every day of your life

To increase daily physical activityWalk, don’t drive; avoid escalators, remote controls

Commit to a lifetime aerobic exercise program45–60 minutes/session, 5–6 times/week during weight loss period

30 minutes/session, 3–5 times/week for weight maintenance

Strength train 2–3 times per weekSelect 10–12 exercises and do 3 sets of 10–12 reps


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Role of Aerobic Exercisein Weight Management

A 45-minute exercise session = 300 calories

5 sessions per week: 300 x 5 = 1,500 calories

52 weeks per year: 1500 x 52 = 78,000 calories

1 lb of fat = 3,500 calories

78,000 calories ÷ 3,500 = 22 pounds of fat


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Role of Strength Training in Weight Management

Each additional pound of muscle tissue may increase BMR by up to 35 calories per day

An increase of 3 pounds would represent:3 lbs x 35 calories x 365 days = 38,325 calories

1 lb of fat = 3,500 calories

38,325 calories ÷ 3,500 = 11 pounds of fat


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Change in Eating HabitsDecrease fat intake: for good

Use primarily mono- and polyunsaturated fats

Eat adequate grains, fruits, and vegetables

Limit meat consumption to 3 oz. per day

Count calories when on a diet

Treat yourself once in a while

Juniorsize, NEVER supersize

Plan prior to socializing around food


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Behavior Modification: Walk across Campus & Drink One Less Can of Pop/Day

Small changes make a BIG differenceWalking a mile a day Monday through Friday =100 calories x 5 days = 500 calories/weekEliminate the equivalent of a daily can of soda pop =160 calories x 7 days = 1,120 calories/week500 + 1,120 = 1,620 calories/week1,620 calories x 52 weeks = 84,240 calories/year84,240 calories ÷ 3,500 = 24 pounds of fat


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College Nutrition

Monitoring Caloric Intake

People who are successful in losing weight carefully monitor caloric intake


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5.9Making Wise Food ChoicesBreakfast

5.9Making Wise Food ChoicesLunch

5.9Making Wise Food ChoicesDinner

5.3Estimated Energy Requirement (EER) per Pound of Body Weight Based on Lifestyle Patterns and Gender

Target Caloric Intake for Weight Loss

Determine the daily estimated energy requirement (EER)

Determine the total daily energy requirement (TDER) by adding the average daily caloric expenditure through physical activity to the EER

Subtract your body weight x 5 from the TDER


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Food Logs

To help monitor and adhere to a diet plan, use daily food logs

Guidelines are provided for 1,200-, 1,500-, 1,800-, and 2,000-calorie diet plans

The objective is to meet (not exceed) the number of servings allowed for each diet plan


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What Constitutes a Serving?Bread, Cereal, Rice, and Pasta

1/2 of a bun, bagel, or English muffin

1 oz (1/2–1 cup dry cereal)

1 small muffin

1 slice of bread

1/2 cup cooked cereal, rice, or pasta


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What Constitutes a Serving?

Vegetables

1/2 cup cooked or chopped raw vegetables

1 cup leafy vegetables

1/2 cup vegetable juice


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Fruit

1 medium piece of fruit

1/2 cup of canned fruit

3/4 cup fruit juice

1/4 cup dried fruit


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Milk, Yogurt, and Cheese

1 1/2–2 oz cheese

1 cup milk or yogurt (skim or 1%)


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What Constitutes a Serving?Meat, Poultry, Fish, Dry Beans, Eggs, Nuts

2 1/2 to 3 oz of cooked lean meat1/2 cup cooked beans1 egg2 Tbsp peanut butter


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Calcium and WeightRecent studies indicate that eating calcium-rich foods (especially from dairy products) helps control or reduce weight

Women with a high calcium intake from dairy sources gain less weight and body fat than those with a lower intakeWomen with low calcium intake more than double the risk of becoming overweightIn the absence of caloric restriction, obese people with high dietary calcium intake (the equivalent of 3 to 4 cups of milk per day) lose body fat and weightBody weight and fat loss is accelerated during calorie-restricted diets in people with high calcium intake


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Calcium and WeightCalcium from dairy sources is more effective in attenuating weight and fat gain and accelerating fat loss than calcium obtained from other sourcesNutrients found in dairy products may enhance the weight-regulating action of calciumResearchers hypothesize that calcium either helps the body break down fat or causes fat cells to produce less fat Although additional research is necessary, if you are attempting to maintain or lose weight, do not eliminate dairy foods from your diet; using nonfat or low fat products may help you lose weight faster


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An Example: Patty’s Body Composition Changes through Diet and Exercise

Initial 4 months 16 months 28 months

BW (lbs) 240 190 200 200

% Fat 41 22.5 21.2 19.5

LBM (lbs) 141.6 147.3 157.6 161

FW (lbs) 98.4 42.7 42.4 39


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Critical ThinkingWhat behavioral strategies have you used to properly manage your body weight?How do you feel those strategies would work for others?


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Behavior Modification &

Weight Management

Behavior Modification Techniques

Make a commitment to change

Set realistic goals

Exercise regularly

Exercise control over your appetite

Consume less fat in the diet

Eliminate unnecessary food items from the dietInclude calcium-rich foods in the dietUse craving-reducing foods in the dietAvoid automatic eating


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Weight Management


Stay busy

Plan meals ahead of time and shop sensibly

Pay attention to the number of calories in foodCook wisely

Do not serve more food than you should eat

Use portion control in the diet and when dining out

Do not eat out more than once per week; when you do, eat low-fat meals

Eat slowly and at the table only


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Weight Management


Avoid social bingesAvoid temptation by relocating or removing unhealthy foodsAvoid evening food raidsPractice stress management

Have a strong support groupMonitor changes and reward accomplishmentsPrepare for lapses/relapsesThink positive


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Weight Management

End of Chapter

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